Back in 2010, Saturday Night Live aired a sketch called “What Is Burn Notice?”—a fake game show based on the idea that while there were ads for USA’s spy series all over the place, none of the contestants could figure out what the heck was being pitched. It was a funny bit, even if its target was misaligned. By the time SNL took a shot at it, Burn Notice had been on the air for nearly three full seasons, and was averaging around 5 million viewers per episode—which was part of the joke, that this show with no real buzz was one of the most-watched things on cable. But Burn Notice was popular for a good reason: It was clever and exciting, with an easy to understand “disgraced secret agent becomes Miami private investigator” hook.

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Now Complications? There’s a show that’s utterly confounding.

Burn Notice creator Matt Nix is the man behind Complications, which he’s said is inspired by something that actually happened to him. A decade ago—before he wrote the show that made his career—Nix caught a criminal breaking into his house. He scared the guy away, then stupidly followed him into the street, and kept asking him questions about why he was there. Imagining a possible worst-case scenario for that encounter, Nix came up with a story about an Atlanta emergency-room doctor who saves the life of a young boy who’s been shot by a gang member. Through a series of knee-jerk reactions and scary threats, the hero ends up becoming more and more involved in a war between local drug kingpins.

The doctor in question is John Ellison, played by Jason O’Mara, a handsome Irish actor who’s had a hard time finding a suitable home on American television. O’Mara’s resumé includes the disappointingly stiff Terra Nova, the spectacularly misguided Life On Mars remake, and one of The Good Wife’s worst-received story arcs. Complications gives him one of the best characters he’s yet played stateside: a suburban family man with an angry edge, who’s still reeling from the death of his daughter, and doesn’t always think before he acts.

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The show as a whole, though, isn’t as well-defined as its hero. In the four Complications episodes sent to critics, Nix seems to be aiming for something like a less arty, more rounded-off Breaking Bad, with Dr. Ellison making a series of well-intended and/or ass-covering decisions that plunge him deeper into trouble. Early on, the jailed gang-lord father of the boy he saved sends goons who demand that John continue to keep the kid safe from their enemies. This forces the doc to fudge some paperwork, and to enlist a streetwise nurse named Gretchen (Jessica Szohr) to help cover his tracks. But Gretchen has her own struggles with impulse control, and she expects John to pay her back by cleaning up her messes. The cycle of desperate scrambling perpetuates itself.

The double-length Complications pilot doesn’t do the best job of setting up the series. Even though it employs the overused storytelling device of starting at a dramatic moment and then jumping back to reveal how we got there, the pilot never develops any real tension or momentum—not even in the “crisis point” it introduces in that first scene. Instead, the first episode is fairly plodding, slowly and carefully setting up not just the series’ premise, but its thematic underpinnings. There are a lot of scenes between John and his work-mandated therapist (played by UnREAL’s Constance Zimmer, who won’t be a regular), where he makes the argument that since he’s sworn to save lives, maybe he needs to get out of the ER and to try to heal the social rifts that lead to gunshot wounds.

To be fair, these are valid, potentially drama-generating questions that Dr. Ellison’s asking. Both the hero and his show appear to fighting back against the feeling of futility that can set in when confronted with an unbeatable problem—be it terminal cancer or a community mired in violence. In the fourth episode, John delivers what could be Complications’ thesis statement when he shuts down an upper-class acquaintance’s idle cocktail party chatter about criminality as an infection, and speaks up for a teenage drug dealer as an individual, not a statistic.

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While Complications never really finds its stride in the first four episodes, the second and third are much more compelling than the first, suggesting some potential for the series. Both episodes two and three try to follow some of Breaking Bad’s model of saddling characters with time-sensitive no-win situations, and then watching as they come up with solutions that don’t exactly extinguish the fire so much as hastily construct a buffer. As he proved with Burn Notice, Nix has a knack for this kind of screw-tightening, and a willingness to satisfy episodic television’s demand for some occasional narrative closure without just pushing the reset button at the end of each hour. (Another welcome carryover from Burn Notice: Complications doesn’t too get corny with its Atlanta setting. There are very few southern accents, for example.)

At the same time, Complications’ general adherence to conventionality—juggling a roster of supporting characters and subplots, driven by the steady stream of hospital patients—keeps even the better episodes from being as gripping as they could be. Outside of its offbeat inciting incident, nearly every storyline is hackneyed. There’s one about an abused patient who refuses to press charges against her boyfriend, forcing Gretchen to bend the rules to save her. There’s another about an old extramarital affair that has the potential to flare back up. In yet another, a patient kills himself while the staff’s not looking, opening the hospital up to the threat of a lawsuit from his family.

These are all familiar plots, which in Complications often distract from the more engaging main story of Dr. Ellison’s increasingly dangerous adventures in gangland—and start to feel way too protracted by episode four, which stalls in a way that re-raises doubts about the show’s long-term viability. The fourth episode also ends with what’s easily Complications’ worst sequence so far, intercutting a sex scene with a drug-related murder. And calling that the worst is saying something, given that the pilot includes a scene where John’s therapist warns that if he carries his hero complex outside the hospital, “There will be complications.”

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Maybe the real issue is that this show is starting with a single story idea and then building characters and a setting around it, which—Breaking Bad aside—is something that rarely works on television. Given that Nix is a bright guy with a good feel for the medium, it’s possible that Complications will straighten out by the end of this first season and focus more on the big social questions and tense dramatic conflicts that represent the best of these first episodes. So far though, the neither-here-nor-there quality of the series only makes it harder to figure out how Nix is going to turn all these seemingly commercial elements into something long-running. Where exactly is this all headed? What is Complications?